Table 6. Clinical, anatomical and procedural factors that influence the choice of treatment modality for an individual patient.

	Favours TAVI	Favours SAVR
Clinical characteristics
Lower surgical risk	−	+
Higher surgical risk	+	−
Younger agea	−	+
Older agea	+	−
Previous cardiac surgery (particularly intact coronary artery bypass grafts at risk of injury during repeat sternotomy)	+	−
Severe frailtyb	+	−
Active or suspected endocarditis	−	+
Anatomical and procedural factors
TAVI feasible via transfemoral approach	+	−
Transfemoral access challenging or impossible and SAVR feasible	−	+
Transfemoral access challenging or impossible and SAVR inadvisable	+c	−
Sequelae of chest radiation	+	−
Porcelain aorta	+	−
High likelihood of severe patient-prosthesis mismatch (AVA <0.65 cm2/m2 BSA)	+	−
Severe chest deformation or scoliosis	+	−
Aortic annular dimensions unsuitable for available TAVI devices	−	+
Bicuspid aortic valve	−	+
Valve morphology unfavourable for TAVI (e.g. high risk of coronary obstruction due to low coronary ostia or heavy leaflet/LVOT calcification)	−	+
Thrombus in aorta or LV	−	+
Concomitant cardiac conditions requiring intervention
Significant multi-vessel CAD requiring surgical revascularizationd	−	+
Severe primary mitral valve disease	−	+
Severe tricuspid valve disease	−	+
Significant dilatation/aneurysm of the aortic root and/or ascending aorta	−	+
Septal hypertrophy requiring myectomy	−	+
AVA: aortic valve area, BSA: body surface area, CAD: coronary artery disease; ESC: European Society of Cardiology; LV: left ventricle/left ventricular; LVOT: left ventricular outflow tract; SAVR: surgical aortic valve replacement; TAVI: transcatheter aortic valve implantation. Integration of these factors provides guidance for the Heart Team decision (indications for intervention are provided in the table of recommendations on indications for intervention in symptomatic and asymptomatic aortic stenosis and recommended mode of intervention). aLife expectancy is highly dependent on absolute age and frailty, differs between men and women, and may be a better guide than age alone. There is wide variation across Europe and elsewhere in the world (http://ghdx.healthdata.org/record/ihme-data/gbd-2017-life-tables-1950-2017). bSevere frailty: >2 factors according to Katz index59 (see section 3.3 for further discussion). cVia non-transfemoral approach. d According to the 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.